HPRO Card: An Overview of Health Professionals’ Identity Management within Europe. Cimino M. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Contribution to:
Interoperability of health professionals’
authentication in Europe
Barcelona
March 16, 2010
Mariane Cimino, HPRO Card, ASIP-santé, France

2. General overview
Phase 0 Phase 1 Phase 2 Phase 3 Phase 4
Work on
professional Presentation HPRO Pilots and
HPRO Card
qualifications to EP implementation
Oct. 2007
Directive HPRO Card with a Access management
2005/36/CE harmonized to applications
European face •Competent authorities • Governance
(ex. Electronic Health
•Existing H Pro systems • HCP identity federation
Record,
•Possible architectures framework
e-prescription)
•Interoperability issues • Pilot epSOS, STORK…
Past situation Present Future situation

3. HPRO Card workpackages
• WP1 : Identification of the competent authorities for
health professionals in EU
• WP2 : Identification of health professionals cards in
Europe
• WP3 : Conditions for implementation of strong
authentication of health professionals
• WP4 : Interoperability between different health
professionals authentication systems
• WP5 : Project management
• WP6 : Dissemination
From March 2008 to November 2009

4. Interoperability levels
Jurisdiction # 1 Jurisdiction # 2
Function A Function A
Top-
Down Political / Legal Political / Legal
IOp Agreement
Interface; Mapping;
Translation ...
Organisational Organisational
Semantic Semantic
Bottom
-up Technical Technical
Education & Awareness raising

5. Interoperability levels in ID
management
Legislation,
Political / Legal nomination of responsible authorities,
definition of covered entities
Organisational Registration procedures,
verification procedures
Data models,
Semantic identifiers, numbering systems
Certificates,
Technical ID-tokens (e.g. cards),
directory databases, networking
infrastructure

6. Electronic certificates’ production
Registration Certification Publication
authorities authorities authorities
5 professions PKI Databases or
27 state-members Validation authorities Repositories
893 Competent
authorities Access profiles

7. Competent Authorities
Directive 2005/36 (5 health professions)
Identification of the
competent authorities
Process of registration

8. Results
How many competent authorities in EU ?
about 893 competent authorities identified
They can be classified in two main categories :
- Professional organizations: Orders, Chambers, Associations …
- State organizations: Ministry of Health, Agencies,
- Health insurance…
Depending on the administrational and political organization of each
country, they can be organized at the:
- National level (Sweden …)
- Regional level (Germany …)
- Local level (Italy …)

9. For example: Workflow for Estonia
Conclusion for Estonia :
Competent Authorities = Health Care Board
HP Diploma’s Right to practise Id’s Sanction’s HP card’s
provider provider provider provider provider
University (Initial procedure or
training 2 Health care colleges****
changes in the professional situation)
diploma
Health Care Board* Professional associations**
registration documents
State sanction / no sanction
Agency right to practice / or not
National Health Care Board*
Automatic calculation of the
level Code in the registry (Kood)
registration documents
identifier Id Card (for all citizens***) with :
Name, Surname, Id Code, Date
of birth, Date of validity…
registration documents
* governmental agency, which started operations on 1st of January 2002 under the jurisdiction of HP card
the Ministry of Social Affairs, according to the Health Services Organization Act
** one association by profession, the sanctions are not registered (due to regulation on privacy)
*** there is no plan to issue professional cards
**** for nurses and midwives

10. For example: Workflow for Spain
Conclusion for Spain :
Competent Authorities for Doctors = OMC
HP Diploma’s Right to practise Id’s Sanction’s HP card’s
provider provider provider provider provider
training Universities CGCOM** :
(Initial procedure or
• Central Registration Database
changes in the professional situation) 52 …/… • Central Ethics Commission
diploma
Regional Medical Councils* Regional Medical Councils*
registration documents CGCOM**
52 …/…
Professi
onal sanction / no sanction
organiza right to practice / or not
tions
Regional Medical Councils
Regional registration documents in coordination with CGCOM** 52 …/…
level
identifier Regional Medical Councils 3***
in coordination with CGCOM**
registration documents : smart cards
* 52 Regional Medical Councils in the 17 autonomous regions HP card
dental surgeons ?? pharmacists ??, nurses ??, midwives ??
** CGCOM : El Consejo General de Colegios Oficiales de Médicos : The Spanish Medical Association groups
together all Autonomous and Regional Medical Councils, and is the responsible of the relations with State
Government and at the international level.
*** Barcelona, Girona and national level

11. For ex: Workflow Czech Republic
Conclusion for Czech Republic
- Pharmacists, dentists and physicians : national chambers
-Nurses and midwives : Ministry of Health
HP Diploma’s Right to practise Id’s Sanction’s HP card’s
provider provider provider provider provider
(Initial procedure or
Universities changes in the professional situation)
training
diploma Ministry of health **
Ministry of health **
registration documents Chamber * Chamber *
Mixed sanction / no sanction
Nature right to practice / or not
Ministry of health **
Chamber *
National registration documents Health insurance
level
identifier
registration documents No document
HP card
* : for pharmacists, dentists and physicians
** : for nurses and midwives

12. Results
How many professionals in EU ?
WHO’s database
• Physicians: 1 543 500
• Dental practitioners: 303 900
• Pharmacists: 341 000
• Nurses: 3 488 400
• Midwives: 100 900
5 777 700 healthcare professionals in Europe
HPRO Card’s database
• 10 to 35% of discrepancies between WHO and HPRO databases
e.g. this represents a difference of 24000 HCP in Belgium, 169000 HCP in Poland
• 52% of discrepancies for Spanish nurses (= 110000 nurses)
• 87 % of discrepancies for Swedish pharmacists (= 2500 pharmacists)
Different dates, different definitions (active/non active persons…)

13. Health professionals’ identity
documents
• Some countries have no card. For example, Poland issues
a professional passport and Luxembourg has a paper
certificate
• Some have plastic or paper cards. For example, France or
Ireland

14. Existing health professionals’
smart cards
• Austria
• Pharmacists (Apothekerausweis)
• Doctors in contract with social insurance (Ordinationskarte or o-card)
• France
• All professions (Carte de Professionnel de Santé CPS)
• Germany
• Doctors (Arztausweis)
• Hungary
• Doctors
• Italy (Lombardy)
• All professions (Carta SISS)
• Netherlands
• All professions (UZI-pas)
• Portugal
• Dentists
• Slovenia
• All professions (Profesionalna kartica)
• Spain (3 regions)
• Doctors (Carné de médico colegiado)
• Sweden
• All professions (SIS card and SITHS card)
• UK
• All professions (NHS CRS smartcard)

15. Projects of health
professionals’ cards
• Belgium (2010)
• Pharmacists
• Finland (2011)
• All professions
• Hungary (2011)
• Doctors
• Dentists
• Pharmacists
• Ireland
• Pharmacists
• Italy (Latina)
• Doctors
• Dentists
• Luxemburg
• All professions
• Slovakia (2010)
• All professions
• Spain
• Pharmacists
• Switzerland
• Doctors
• …

16. e-Identity cards for health
professionals
• eID card used by the doctors, for instance in
Estonia
• Belgium eID card used on the eHealth platform
• Potential eID card used by doctors in Norway

17. Proposed architecture
HPRO-Card.es HPRO-Card.fr
3. Verification of access rights PKI
Validation CR
demand/response L
4. Secured access on 2. Validation of the certificate
the right application
1. Authentication
Application

18. Technical materials on 23
different systems

19. Health professionals’ databases
• Some online examples :
Austria: doctors
Czech republic : doctors, dentists and pharmacists
Estonian: doctors and pharmacists
France: all regulated professions
Lithuania : all regulated professions
Ireland: nurses and midwives
Norway : all regulated professions
Poland: doctors and dentists
Portugal : dentists
Spain: doctors
UK: doctors and pharmacists

20. Health professionals’ databases

21. Health professionals’ databases
•Evidenční číslo: Evidence
number
•Jméno a příjmení: Name and
surname
•Místo výkonu povolání:
Instead profession
•Odbornost: Expertise
•Licence: License
In the register there are
additional information (non
public ones) :
•date of birth
•address

22. Use Case 1
• A health professional wants to practice in
another EU State Member for a temporary
providing of services.
• Studied issue : at which conditions he can use
the workstation + card reader + application of
the foreign country ?

23. German demonstrator
Country A Country B
Authentication Authentication
signature signature

24. Middlewares
Applications
?
Citizen card Own software PKCS#11 Konnektor PKCS#11 With the UZI- Classic Client G&D Common CSP
middleware spezifikation card the 5.1.7 - 004 SafeSign 2.2 (Cryptographic
MS CAPI
that origins standard for ZZZS Software
from CDSA SafeSign Provider) who
eGovernment Identity Client understands
programmes middleware is PKCS#15 file
provided from
+ coop with
A.E.T.
CSP provider
Europe B.V
(SecMaker and
for Windows,
their application
MacOS X
– NetID) : both
and Linux.
client and
server
additional
functions, such
as “Single-sign-
on”
Austria Austria France Germany Italy Netherlands Slovenia Spain Sweden
Workstation + reader

25. Use Case 2
• A health professional has to access medical data
of a foreign patient in the patient’s country of
origin
• Studied issue : at which conditions he can
authenticate himself and receive the access
rights ?

26. Spanish French medical
demonstrator consultation
Spanish patient
Form and
signature
(PDF)
Spanish hospital
Reply
Verification request
Spanish Medical Chamber
Reply Verification request
French Order of doctors
Phase 1
Phase 2
Phase 3

27. Access for foreign doctors
to Xarxa Sanitària i Social de Santa Tecla

28. e-signature of the patient
to give access to a foreign doctor

29. e-Signature of the foreign doctor

30. Verification of the foreign doctor
HPRO.es
French doctor
HPRO.fr

31. Belgium demonstrator
2 2
1 1 1 1
1
Belgium pharmacist card
French pharmacist card
French health
French pharmaceutical assurance card
record (4 months-history of
delivered medicines in every
French pharmacies)

32. Use Case 3
• A health professional wants to be recognized as
a health professional in another country
• Studied issue : how can we verify the
authenticity of his card ?

33. Belgium
demonstrator Website
Result

34. Perspectives and orientations
Cartography of health professionals ID
tools and databases
How to provide an infrastructure to
interoperate at the EU level ?

35. More information
www.hprocard.eu
mariane.cimino@sante.gouv.fr